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Evaluation article: CQC inspections: site visits

Published: Tuesday, 08 September 2015

Martin Hodgson looks at the format of a CQC inspection site visit and what providers can expect.

Summary

  • CQC inspections using the new five key question test are nearly always unannounced unless there is a good reason to let a provider know that inspectors are coming.
  • The CQC will explicitly seek out the views and experiences of people who use services to help inform its decisions about how a provider is performing.
  • Inspectors will wish to speak to the staff on duty at the time of the inspection, including managers, care staff and support staff.
  • Inspectors will ask to be shown various information and records, according to what areas of care or the running of the service they are interested in.
  • At the end of the inspection visit, the inspector will hold a feedback meeting with the registered manager, nominated individual or other senior person in charge on the day.

Site visits are a key element in the inspection process. They allow CQC inspectors to talk to people and observe first-hand how care is provided. CQC inspections using the new five key question test are nearly always unannounced unless there is a good reason to let a provider know that inspectors are coming. The CQC believes that in this way inspectors can get the best picture of how a service is operating.

Start of the site visit

When inspectors arrive they will introduce themselves and show their identification. They will ask to speak to the registered person or the nominated individual. If these are not available, the inspectors will ask to speak to the senior person in charge.

The inspectors will ask for a suitable room or place for them to use for the duration of their visit. They will use the room to interview staff and people who use the service, their relatives, advocates or carers.

The CQC says it will usually allow a provider time to organise themselves but may start their inspection before a senior person is contacted if they have specific concerns.
During each visit the CQC inspector will state:

  • the five key question areas
  • whether any additional key lines of enquiry (KLOEs) will be inspected
  • whether the inspection is following up on any previous issues
  • the proposed length of the inspection
  • the roles of the inspection team members
  • who they plan to speak with
  • documents they want to review
  • how they will feed back about what they found during the inspection.

Inspectors may look at specific areas of a service (e.g. how medicines are administered and managed).

Talking to service users

Inspectors will seek out the views and experiences of people who use services to help inform their decisions about how a provider is performing. During the visit the inspectors will gather the views of people who use services and those close to them. This will include gathering the experiences of people who use services who may not be able to fully describe these themselves – for example, people with learning disabilities and those living with dementia and other conditions that may affect their ability to communicate.

Gathering information from staff

As well as speaking to service users and their families, inspectors will also wish to speak with the staff on duty at the time of the inspection. This will include staff of all types and grades, including managers, care staff and support staff.

The CQC says it may spend time carrying out what it calls ‘pathway tracking’. This is a process where inspectors follow a ser-vice user’s route through a service. This is considered an important part of inspection, as it allows the CQC to capture information about a sample of people receiving care or treatment.

Observations and reviewing records

Inspectors will spend some time observing care, but not intimate personal care. They will also want to see documents and records such as care pathways, medication records and care notes.
The inspectors will ask to be shown various information and records, according to what areas of care or the running of the service they are interested in. For example, they may wish to look at training records or medicine administration records.

When there is a team carrying out the inspection, the lead inspector will continually review the emerging findings with the team.

" Registered persons and managers should read the information in the provider handbooks so that they are aware of what inspectors will be looking for."

Ending the visit

At the end of the inspection visit, the inspector will hold a feedback meeting with the registered manager, nominated individual or other senior person in charge on the day of the inspection. They will provide high-level feedback, which might include identifying any immediate actions required. At this stage they will not provide rating information.

After the visit

The CQC will work hard to ensure that its ratings judgements are consistent; thus it employs established quality assurance procedures before the final rating and report can be agreed.
Following the quality checks, the CQC sends a draft report to the provider for comment on its factual accuracy. Any necessary changes are made and the completed report is sent to the provider. The CQC will also write to the provider with the overall sum-mary of the report for them to share with each person using their service, their family and carers and the staff of the service.

The CQC will ask providers in breach of regulations to send it a written report of the action they will take to achieve compliance.

Inspectors will publish their inspection reports and ratings on the CQC website soon after completing the quality assurance process.

Preparing for inspection

Visits can happen at any time, including evenings and weekends, so it is important that staff and managers are well prepared and know what to expect. There is no need for staff and managers to be nervous, or to act in a defensive way. They should be encouraged to be polite, open and honest with inspectors.

Before an inspection, the CQC team will have used intelligent monitoring information to build a picture of what a service is like and how it is performing. Pre-inspection information requested by inspectors will include a completed PIR form.

Other pre-inspection intelligent monitoring information is gathered from such things as the notifications received from a provider, concerns, complaints and safeguarding alerts, and contract monitoring reports.

It is thus important for providers to make sure they have completed their PIR return promptly when requested and have submitted notifications in a timely way throughout the year, so that inspectors have a clear picture of the service and there are no anomalies.

For a service that seeks as high a rating as possible, people who use the service should be encouraged to complete the ‘Please tell us your experience’ forms on the service’s profile page on the CQC website. Again, this helps the CQC understand how people experience the service.
Registered persons and managers should read the information in the provider handbooks so that they are aware of what inspectors will be looking for when they visit, especially the KLOEs, which prompt inspectors to ask certain questions and look for certain sources of evidence. By being well prepared, managers and providers can know their strengths and ensure that they have suitable information and data to hand.

Providers may want to:

  • identify a suitable room in advance that the inspectors can use
  • identify a member of staff who can help show inspectors around and introduce them to people
  • brief staff so that they know what to expect during the inspection
  • ensure that contact details for the registered person are available.

Providers should take particular care to ensure that all appropriate records are up-to-date and available. The CQC says inspectors will not be prescriptive in what they expect from records as they recognise that differences in settings will mean different records. However, inspectors will expect records to be sufficiently detailed and accurate to ensure people receive safe care and good outcomes.

This information was originally published in the Fundamental Standards Compliance Toolkit, Forum Business Media Ltd, December 2014.  www.fundamentalstandardstoolkit.co.uk

Toolkit

Use the following items in the Toolkit to help you to put the ideas in this article into practice:

About the author

Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.

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